CS323179-A | 03/15/21

COVID-19 State of Vaccine 

Confidence Insights Report

Report 3 | March 15, 2021 | Date Range: February 16, 2021 – March 1, 2021

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).

Contents

3 Johnson & Johnson’s Janssen COVID-19 

Vaccine raises concerns about equity for 

communities of color.

4 “Wait and see” consumers need trusted 

messengers and champions to increase 

vaccine confidence.

5 Concerns about vaccine effectiveness and lack 

of normalcy after vaccination are undermining 

vaccine confidence.

6 Emerging Topics

8 Continuing Themes

9 Appendix: Inputs and Sources

Centers for Disease Control & Prevention, 

COVID-19 Response, Vaccine Task Force

Vaccine Confidence Team, Insights Unit

Summary

Findings. Since the introduction of a third authorized COVID-19 vaccine in the United States, many people feel 

optimistic that a return to normal life is within reach. However, people’s concerns about the effectiveness of 

Johnson & Johnson’s Janssen COVID-19 Vaccine raise new threats to vaccine confidence. Consumers are afraid 

that the J&J/Janssen COVID-19 vaccine is an inferior product and that it will be distributed to racial and ethnic 

minority groups, and people with lower incomes, underscoring the need for trusted messengers to amplify 

messages about the effectiveness of all three vaccines. The percentage of adults wanting to “wait and see” 

before getting vaccinated continues to decrease, but those who remain in this category are more likely to be 

from communities of color and younger adults. They are also less likely to know someone who has already been 

vaccinated. Those who are already vaccinated and those who are considering vaccination are confused about 

safety guidelines for life after vaccination. They are primarily concerned about whether those who are vaccinated 

can spread the virus that causes COVID-19 through asymptomatic transmission, if quarantine guidelines from 

states still apply, and whether vaccination offers protection from SARS-CoV-2 variants.

Recommendations. Federal, state, and local partners should continue to work together to increase 

transparency, respond to gaps in information, and confront misinformation with evidence-based messaging. The 

goal of these efforts is to increase confidence in COVID-19 vaccines and expand vaccine uptake more broadly. 

Effort should be made to find trusted messengers who can connect with these groups to better understand 

information gaps and voids, promote facts and dispel misinformation about COVID-19 vaccines, 

and ultimately improve vaccine confidence.
COVID-19 State of Vaccine Confidence Insights Report | Report 3 | March 15, 2021

Aims and Methods

By rapidly reviewing and analyzing numerous sources and inputs (see Appendix), the biweekly COVID-19 State 

of Vaccine Confidence Insights Report emphasizes major themes influencing COVID-19 vaccine hesitancy and 

uptake, categorized by their level and type of threat to vaccine confidence, degree of spread, and directionality. 

By examining how consumers think and feel, social processes, and the practical issues around vaccination, 

the Insights Report seeks to identify emerging issues of misinformation, disinformation, and places where 

intervention efforts can positively impact vaccine confidence across the U.S.

The information in this report is a snapshot and certain populations may be underrepresented. Images 

and quotes are illustrative examples and are not meant to be comprehensive of all content related to the 

highlighted themes.

Theme Classification

How do you classify this theme/information?

High risk Moderate risk Low risk

 May lead to vaccine refusals and 

decreased uptake

 Wide reach, pervasive

 Potential to trigger hesitancy to 

vaccinate

 Moderate reach, modest 

dissemination

 Concerning, but low risk to vaccine 

confidence

 Limited reach, limited dissemination

How has this theme/idea changed over time (since last report or over the course of multiple reports)?

Increasing 

Information spreading rapidly

Stable 

Information remaining 

constant at prior level

Decreasing

Information is not gaining further 

traction and there has been no 

indication of additional activity
COVID-19 State of Vaccine Confidence Insights Report | Report 3 | March 15, 2021

Major Themes

Johnson & Johnson’s Janssen COVID-19 Vaccine raises concerns about equity 

for communities of color.

The introduction of a third vaccine was met largely with positivity and relief, with 

62% of consumers in a recent survey saying that the worst of the pandemic may 

now be behind us.2

 However, concerns about the J&J/Janssen COVID-19 vaccine’s 

effectiveness relative to the other two COVID-19 vaccines are driving fears that 

the vaccine is an inferior product and that it will be distributed to racial and ethnic 

minority groups, and people with lower incomes. In online conversations, 45% 

of J&J/Janssen COVID-19 vaccine mentions were related to vaccine effectiveness, 

and CDC-INFO inquiries on vaccine ingredients by brand increased by at least 

10%. Because the single-shot vaccine is easier to store and administer, J&J/Janssen 

COVID-19 vaccine may offer a solution for reaching those without stable housing 

or living within the criminal justice system. But because people of color are 

overrepresented in both populations, such distribution plans may underscore the 

perception that the J&J/Janssen COVID-19 vaccine is prioritized for racial and ethnic 

minority groups, and groups and people with lower incomes.3

Vaccine confidence may be threatened because people think that the 

J&J/Janssen COVID-19 vaccine is less effective compared to the Pfizer-BioNTech 

and Moderna COVID-19 vaccines. Others may have underlying distrust of the 

Johnson & Johnson company,i given prior lawsuits regarding potential carcinogens. This could threaten vaccine confidence in 

the J&J/Janssen COVID-19 vaccine brand specifically. Baby boomers (age 55–75 years) are among the most skeptical of the J&J/

Janssen COVID-19 vaccine, with 22% stating that the new vaccine is less effective;4

 however, 26% of people in the “wait and see” 

group would get the J&J/Janssen COVID-19 vaccine over the other two vaccines5 and 64% of people say they would get the 

J&J/Janssen COVID-19 vaccine if it were available to them.6

Short-term recommendations:

 Identify local, trusted messengers within communities of color to relay the message that all vaccines similarly prevent 

hospitalization, ICU admission, and death from COVID-19. Partner with healthcare providers to allay fears and communicate 

the effectiveness of all three vaccines to prevent COVID-19 disease and serious illness.

 Amplify messaging about vaccine effectiveness and efficacy, including how they are determined, what they mean, and how 

consumers should interpret the vaccine effectiveness statistics in vaccine branding.

Long-term recommendation:

 If a distribution plan for a community or population relies on a single vaccine, ensure that any appearances of in inequitable 

distribution based on membership in a racial and ethnic minority group, or people with lower incomes are addressed head-on 

and with transparency. Partner with states and jurisdictions to evaluate the advantages of offering the J&J/Janssen COVID-19 

vaccine from both accessibility perspective as only standard refrigeration temperatures are needed and a convenience 

perspective as it is the only 1-dose vaccine available, while also considering any long-standing trust concerns and historic and 

ongoing harms experienced by racial and ethnic minority groups.

i

 Social Listening Team. COVID-19 Interagency Social Listening Report. Washington, DC, Federal Emergency Management Agency; February 24, 2021.

“If we end up with a 

hierarchy that says all rich 

White people get Pfizer, 

and all poor Black people 

get J&J, that would be a 

problem,” said Helene D. 

Gayle, president and chief 

executive of the Chicago 

Community Trust, one of 

the largest community 

foundations in the 

country.1
COVID-19 State of Vaccine Confidence Insights Report | Report 3 | March 15, 2021

“Wait and see” consumers need trusted messengers and champions to increase 

vaccine confidence.

The percentage of adults wanting to “wait and see” before getting 

vaccinated continues to decrease; those remaining in the “wait 

and see” category are more likely to be from communities of color 

and younger adults and are less likely to know someone who has 

been vaccinated.7

Some Americans, especially Generation Z, Millienial, and Black 

or African American persons, feel that vaccinating NBA players 

or other professional athletes is a good way to build public 

confidence in COVID-19 vaccines.8

 However, many NBA players 

express concerns about the vaccines and whether they might 

negatively impact their performance.9

 Side effects remain the 

top concern of those who want to “wait and see” before getting 

vaccinated, along with concerns about missing work due to side 

effects, concerns about the vaccine giving them COVID-19, and 

questions about the cost of vaccination.10 Black and Hispanic 

adults wanting to “wait and see” were also worried that they would 

not be able to get vaccinated in a place they know and trust.11

Additionally, consumers wanting to “wait and see” are more 

likely to be exposed to misinformation about COVID-19 vaccines, 

which undermines vaccine confidence and ultimately decreases 

vaccine uptake.12 Many Black and Hispanic adults express feelings 

of distrust in the government and the U.S. health system, and 

this lack of trust has been exacerbated by the pandemic, making 

outreach and communication via trusted messengers an essential 

tool to increase vaccine confidence.13

Short-term recommendations:

 Partner with states and jurisdictions to identify localized, 

community-based organizations and deploy trusted messengers 

to communicate key strategies and messages. Expand available 

toolkits to include innovative practices for identifying trusted 

community messengers and utilizing microinfluencers.

 Empower healthcare professionals to relay information about 

vaccine side effects, what to expect after vaccination, and 

how to prepare for vaccination appointments. Strengthen the 

capacity of healthcare professionals to have empathetic vaccine 

conversations, address myths and common questions, and 

provide tailored vaccine information to patients.

Long-term recommendation:

 Work with national organizations focused on Black and Hispanic persons to plan studies to better understand vaccine 

confidence among communities of color and develop consumer education campaigns based on findings and implications.
COVID-19 State of Vaccine Confidence Insights Report | Report 3 | March 15, 2021

Concerns about vaccine effectiveness and lack of normalcy after vaccination 

are undermining vaccine confidence.

Vaccinated consumers and consumers considering vaccination are confused about 

guidelines and recommendations for life after vaccination, including those recently 

released by CDC. As a larger share of the population becomes fully vaccinated, 

people continue to be concerned about asymptomatic transmission. While some 

studies seem to report that the currently available vaccines may have an impact 

on asymptomatic transmission,14 there is a lack of consensus among the scientific 

community about what is known and not known about asymptomatic spread by 

vaccinated people.15

Because of the uncertainty related to asymptomatic spread, vaccinated people 

continue to be confused about whether they should quarantine before or after 

travel or if they are in contact with unvaccinated people. Some people want to 

know if their vaccination status would replace the need for testing requirements 

before and after traveling, while others strongly oppose the concept of a “vaccine 

passport.”16

Lastly, each new cluster of SARS-CoV-2 variants draws high 

levels of media coverage, with many outlets spotlighting 

concerns about vaccine effectiveness.17,18 Reports of 

“breakthrough” cases of COVID-19 among fully vaccinated 

healthcare workers19 are fueling vaccine skepticism and 

anxiety.20 Such media coverage underscores the perception 

that the risks of vaccination may not outweigh the benefits, 

which eventually reduces vaccine uptake.

Short-term recommendation:

 With the launch of CDC’s new web page for those who are fully vaccinated, continue to communicate what it means to be 

fully vaccinated, both what is known and what is unknown about COVID-19 transmission and variants, and the need for 

sustained preventive actions. Continue to share clear, complete, and accurate messages about COVID-19 vaccines to build 

trust in the vaccines and the health system. Provide regular updates on the benefits, safety, side effects, and effectiveness of 

vaccines.

I already have my second 

vaccine dose. I am planning to 

visit my son in Boston, he lives 

alone with his wife, and they 

don’t have their vaccines yet. Is 

it recommended that I follow 

a quarantine when I arrive in 

Boston? 

— CDC-INFO, 2/21
COVID-19 State of Vaccine Confidence Insights Report | Report 3 | March 15, 2021

Emerging Topics

Questions and conversations about mixing vaccine brands are growing.

Web searches and CDC-INFO inquiries indicate increased interest in “brand-mixing,” or attempts to be vaccinated with more than 

one brand of vaccine in an effort to increase vaccine efficacy and effectiveness.

Short-term recommendation:

 Continue to clearly communicate to consumers that they should not interchange vaccine brands and they should complete 

the vaccine series with a single vaccine brand.21 Develop messaging to de-bunk that mixing vaccine brands would increase 

protection against COVID-19 illness.

Rise in vaccine brand preferences and “vaccine shopping” among consumers.

Although media outlets have attempted to counteract perceptions that some vaccines are 

better than others, social media posts and web traffic indicate that those who are eligible 

for vaccination may adopt a consumer-driven approach and delay vaccination in order to 

receive the vaccine they believe is best and most effective.22

Short-term recommendation:

 Underscore messaging about vaccine effectiveness and efficacy of the three vaccines, 

including how consumers should interpret the vaccine effectiveness statistics in 

vaccine branding.

Misinformation about people “shedding” the virus that causes COVID-19 after 

vaccination is growing.

While volume is currently low, confusion about whether people can 

spread or “shed” the virus that causes COVID-19 as a result of being 

vaccinated is beginning to slowly increase on social media and through 

calls to CDC-INFO.

Short-term recommendations:

 Expand messaging and content about how vaccines work, 

especially the new viral vector vaccine, to explain how virus 

“shedding” is not possible.

 Engage healthcare personnel and professional healthcare and 

advocacy organizations around this topic, including content and tools 

to pre-bunk this myth before online conversation volume on this 

topic increases.

Good Evening, If I receive the vaccine, can 

I spread covid to others based off of the 

shot itself? I will keep socially distancing, 

masking, washing hands and all protocols 

in place, but I was wondering if I get the 

vaccine and go straight home after, are 

my parents at risk for contracting the virus 

since I got the shot? This might make 0 

sense, but my sister has me concerned 

about "shedding" Plz help.

email to CDC-info, 2/26
COVID-19 State of Vaccine Confidence Insights Report | Report 3 | March 15, 2021

Confusion is growing about the use of fetal cells in the J&J/Janssen COVID-19 

vaccine.

One archdiocese called for parishioners to avoid J&J/Janssen 

COVID-19 vaccine as it is “morally compromised as it uses the 

abortion-derived cell line in development and production 

of the vaccine as well as the testing.”23 Online conversations 

increased following this report by 78% with over 19,000 

mentions online during the report period.

Short-term recommendations:

 Collaborate with trusted messengers—such as faith-based leaders and faith organizations—to tailor and share culturally 

relevant messages and materials to build vaccine confidence as accurate and transparent communication about the use of 

fetal cells is critical.

Reports of vaccine refusals among military are driving 

misinformation about mandatory vaccination.

There are reports of first responders24 and military members refusing vaccination 

opportunities because they do not trust the vaccines, and current messaging about 

vaccination from direct supervisors is insufficient.25 Additionally, misinformation is 

beginning to circulate about vaccination being forced on members of the military.26

Short-term recommendation:

 Identify and build partnerships with trusted messengers and advocacy organizations 

to deploy targeted messaging.

Consumers are frustrated over wasted doses of vaccine.

Media interest in vaccine wastage and consumer confusion about how vaccine doses could be wasted are growing as vaccine 

demand continues to outpace supply. Concerns around wasting vaccine have led pharmacists to suggest pooling vaccine as a 

means to maximize current supplies.27

Short-term recommendation:

 Partner with states and jurisdictions to develop clear, consistent messaging about how excess doses of vaccine will be 

allocated and plans to reduce vaccine wastage that align with CDC’s recommendations. If possible, include transparent 

communication about how many doses have expired or gone unused and reasoning behind wastage.
COVID-19 State of Vaccine Confidence Insights Report | Report 3 | March 15, 2021

Continuing Themes

Themes below have been noted in Reports 1 and 2 and continue to undermine vaccine confidence. For additional context and 

previous recommendations on these themes, see Insights Report 1 (February 12, 2021)ii and Insights Report 2 (March, 1, 2021).iii

 Pregnancy and vaccination. Expectant parents and parents of newborns continue to be concerned about vaccination during 

pregnancy and while breastfeeding. Amplified by vocal vaccine deniers, misinformation is circulating that vaccines can harm 

women who are pregnant by damaging the placenta or causing other effects that may lead to infertility.28 At the same time, 

new studies indicate increased vulnerability of pregnant women to COVID-1929 and suggest protection for infants when 

breastfeeding mothers are vaccinated.30 Such mixed and complex information means that pregnant women and new mothers 

are urgently seeking reliable medical advice and evidence-based information about the effects of COVID-19 vaccines.

 Vaccine logistics and administration. Consumers continue to report issues with scheduling appointments due to limited 

supply and inadequate systems.31 Concerns that vaccine appointment systems are not up to standards for people with 

disabilities, such as people who are blind or visually impaired, are being discussed in media.32 New recommendation:

 Review appointment systems and work with advocacy groups to ensure that systems are meeting minimum guidelines and 

standards for accessibility for people with disabilities.

ii Insights Unit, Vaccinate with Confidence Team. State of vaccine confidence report: Report 1. Atlanta, GA: Vaccine Task Force, Centers for Disease Control and Prevention; 2021.

iii Insights Unit, Vaccinate with Confidence Team. State of vaccine confidence report: Report 2. Atlanta, GA: Vaccine Task Force, Centers for Disease Control and Prevention; 2021.
COVID-19 State of Vaccine Confidence Insights Report | Report 3 | March 15, 2021

Appendix: Inputs and Sources

Type Input Cadence Sources Tactics for Utilization

Mixed 

Methods

Communication 

Surveillance 

Report

Daily, weekdays Google news

Meltwater

CrowdTangle

Native platform searches

 Share of voice topic analysis to 

identify themes

 Emerging topics 

Tanaq Social 

Listening +Media 

Monitoring Report

Weekly, Mondays Meltwater

Muck Rack

 Sprout Social

 First Draft

 Stronger

Native platform searches

 Trending topics

Demographic and geographic 

conversation monitoring

Meltwater Daily  Facebook, Twitter, Instagram

Blogs

News media

Online forums

 Share of voice topic analysis

 Emerging theme topics

Identify high reach/velocity topics

Social Media 

Listening

OADC Channel 

COVID-19 Post 

metrics

Weekly, 

Wednesdays 

 Sprout Social

Native OADC account analytics

Analyze # of posts, topics

 Success of messages, # 

of impressions, reach, # 

engagements

OADC Channel 

Comment Analysis

Daily, weekdays Native platform searches  Sentiment analysis

Identify message gaps/voids

CrowdTangle 

content insights 

report

Biweekly, 

Mondays

 Facebook  Top pages (voices), groups

General trends/sentiment analysis

News analysis through posts

FEMA Social 

Listening Report

Weekdays, daily Hootsuite

Brandwatch

CrowdTangle

Meltwater

 Trends/sentiment analysis

National and global news analysis

Direct 

Reports

CDC-INFO Metrics Weekly, Mondays CDC-INFO inquiry line list

Prepared response (PR) usage 

report

Cross-compare PR usage with 

inquiry theme analysis

 Sentiment analysis

Identify information gaps/voids

VTF Media 

Requests

Weekly, Mondays Media request line list  Leading indicator for news 

coverage

Identify information gaps/voids

Web Metrics Weekly, 

Wednesdays

 Top pages

Google search queries

 Top FAQs

Referring domains

Identify information gaps/voids,

identify keywords/search terms, 

changes in web traffic

Research

Poll Review Weekly, Mondays Harris Poll, PEW research, Gallup 

Poll, KFF

New data related to vaccine 

hesitancy

Identify socio-behavior indicators 

related to motivation and 

intention to vaccinate 

Literature Review Weekly, Mondays PubMed, LitCovid, ProQuest 

Central

New data related to vaccine 

hesitancy

Identify current vaccination 

intention

Identify barriers to vaccination